Claire Hughes Ph.D.

Family Matters

Family Matters

Infant adjustment is linked to both parents’ prenatal mental health

Posted Feb 11, 2020

They f*ck you up, your mum and dad

They may not mean to but they do.

They fill you with the faults they had

And add some extra, just for you.

As the above excerpt from Philip Larkin’s (1971) poem ‘This be the verse’ illustrates, the idea that parents influence children’s development is far from new. More novel, however, is the idea that this impact of parents begins before birth. For example, studies have shown that signals within the womb affect fetal growth, with potentially long-term adverse effects. An early and striking example of this comes from the increased obesity and adult mortality found in the Dutch Hunger Winter Cohort, whose mothers were pregnant during the famine caused by Nazi food blockades in the 1940s (Lumey et al, 2007).

How might prenatal exposure to risk factors lead to difficulties in later life?  Studies addressing this question have typically focused on physiological mechanisms, but interpersonal processes may also prove important. To test this idea, my colleagues and I tracked 876 expectant first-time parents (438 heterosexual couples living in the Netherlands, the UK and the USA) (Hughes, Devine, Mesman & Blair 2019).  Most of the parents who took part in this study were well-educated and financially secure, such that this was a ‘low-risk’ sample.

As parents know all too well, infant difficulties such as frequent or intense crying and irregular sleep patterns can have a serious negative impact on caregivers’ mental health.  As a result, links between parents’ postnatal mental health and toddlers’ adjustment are difficult to interpret, because they may simply reflect stable infant difficulties.

To avoid this problem, we asked the mothers and fathers in our study to rate their mental health at four separate times from late pregnancy to the infants’ second birthdays – this early start and use of several time-points made it possible for us to compare how strongly prenatal and postnatal mental health problems predicted infant adjustment problems – both ‘acting out’ difficulties and problems of anxiety/ sadness.

Here’s what we found. First, in late pregnancy mothers reported more symptoms of depression and anxiety than fathers, but this contrast had disappeared by the infants’ second birthdays. In other words, average levels of mental health problems remained stable for mothers but increased over time for fathers. Second, even though parental mental health after the birth of the baby showed remarkable variation in both mothers and fathers, in each case it was mental health during the pregnancy that appeared key to infant adjustment. Third, couple relationship difficulties helped explain the link between parents’ mental health difficulties and infant problems of anxiety/sadness. 

These findings suggest three simple practical changes in health-care that could improve new parents’ well-being. First, routine ante-natal health checks should go beyond markers of physical health to include mental well-being. Second, these mental health checks should also include expectant fathers, who often feel overlooked and excluded by health professionals. By considering mothers and fathers in tandem, we were able to show that over-and-above the effects of maternal prenatal well-being, fathers’ prenatal well-being mattered for infant adjustment. As fathers become increasingly involved in childcare in the early years, establishing a dialogue between health-care professionals and fathers can only grow in importance.

At the same time, it is interesting that it was prenatal rather than post-natal wellbeing that showed independent links with infant adjustment. One possible explanation for this hinges on the low-risk nature of the study sample– it may be that it is only in the context of financial strain that parents’ post-natal problems of wellbeing adversely affect infant adjustment.

Third, interventions to support expectant parents that include a focus on their couple relationship may be effective at reducing young children’s feelings of anxiety and sadness, as well as their more overt behavioural difficulties. Plenty of evidence suggests that the transition to parenthood can take its toll on couple relationship quality – the findings highlight the ripple effects that problems within the couple relationship can have on infant adjustment. In other words, simple interventions focused on strengthening couple relationship quality may provide two positive outcomes for the price of one – always a powerful argument in these financially difficult times.

The results from this study indicate that supporting both mothers and fathers across the transition to parenthood is likely to prove valuable in enabling the next generation to make a flying start – regardless of Larkin’s gloomy view!


Hughes, C., Devine, R.T., Mesman, J. & Blair, C. (2019). Parental Wellbeing, Couple Relationship Quality and Children’s Behavior Problems in the First Two Years of Life. Development and Psychopathology, 1-10.